Buruli ulcer is caused by a germ, Mycobacterium ulcerans, that mainly affects the skin but which can also affect the bone. Although the causative organism belongs to the same family of organisms that cause leprosy and tuberculosis, it is unique because it produces a toxin – mycolactone – which destroys tissue. Buruli ulcer has been reported in over 30 countries, but only half of these countries regularly report data to WHO. Most people affected are children under 15 years of age who live in poor rural communities. The introduction of a combination of antibiotics in 2004 has greatly improved treatment outcomes for those who report early; however, late diagnosis can result in long and costly hospitalizations with significant morbidity and disability.